Treatment of severe allergic reactions and anaphylaxis with an adrenaline nasal spray

First-line therapy for a severe allergic reaction (anaphylaxis) is the administration of adrenaline, which, in an emergency, can be self-administered intramuscularly (i.m.) via an adrenaline autoinjector (AAI). Despite the known risk of anaphylaxis, AAIs are often not prescribed, not carried, not used, or used with delay in an emergency. Possible reasons for this include logistical issues (e.g., size and portability of the AAI), difficulties in recognizing symptoms that require the use of an AAI, lack of familiarity with the AAI application, and general fear of injections. Recently, an adrenaline nasal spray (ANS) for intranasal application of adrenaline has been authorized and introduced in Germany. Pharmacokinetic studies for ANS development in comparison with the i.m. injection using an AAI or manual injection (syringe and needle) resulted in comparable profiles. The simple use and small size of the ANS, the needle-free design, and the improved storage conditions can help reduce barriers to adrenaline administration for patients and other users. This may lead to an earlier administration of adrenaline in anaphylaxis treatment.